The feeling that one will not experience positive emotions, or an improvement in one's condition

Anorexia

Avoidance behaviors

Decreased affective display

Decreased initiative

Decreased response to stimuli

Decreased verbalization

Depressive symptoms

Expresses despondency

Expresses diminished hope

Expresses feeling of uncertain future

Expresses inadequate motivation for the future

Expresses negative expectations about self

Expresses negative expectations about the future

Expresses sense of incompetency in meeting goals

Inadequate involvement with self-care

Overestimates the likelihood of unfortunate events

Passivity

Reports altered sleep-wake cycle

Suicidal behaviors

Unable to imagine life in the future

Underestimates the occurrence of positive events

NANDA-I approved*

Pathophysiologic

Any chronic or terminal illness (e.g., heart disease, diabetes, kidney disease, cancer, acquired immunodeficiency syndrome [AIDS]) can cause or contribute to hopelessness.

Related to impaired ability to cope secondary to the following:

Failing or deteriorating physiologic condition

New and unexpected signs or symptoms of previously diagnosed disease process (i.e., recurrence of cancer) (*Brothers & Anderson, 2009)

Prolonged pain, discomfort, and weakness

Impaired functional abilities (walking, elimination, eating, dressing, bathing, speaking, writing)

Treatment Related

Related to:

Prolonged treatments (e.g., chemotherapy, radiation) that cause pain, nausea, and discomfort

Treatments that alter body image (e.g., surgery, chemotherapy)

Isolation for infectious disorders

Reverse isolation for compromised immune system

Situational (Personal, Environmental)

Related to:

Chronic stress*

Fear *

Inadequate social support*

Loss of belief in spiritual power*

Loss of belief in transcendent values *

Low self-efficacy*

Prolonged immobility*

Social Isolation *

Unaddressed violence*

Uncontrolled severe disease symptoms*

Prolonged activity restriction (e.g., fractures, spinal cord injury, imprisonment)

Abandonment by, separation from, or isolation from significant others (Brothers & Anderson, 2009)

Inability to achieve valued goals in life (parenthood, marriage, education)

Impaired relationships (separation, divorce)

Loss of job, career

Loss of significant others (death of spouse, child)

Multiple miscarriages

Inability to participate in desired activities (walking, sports, work)

Loss of something or someone valued (spouse, children, friend, financial resources)

Prolonged caretaking responsibilities (spouse, child, parent)

Recurrence of cancer

Exposure to long-term physiologic or psychological stress

Ongoing, repetitive losses related to AIDS

Repetitive nature disasters (hurricanes, tornadoes, flooding, fires)

Prolonged exposure to violence and war

Maturational

Child

Multiple losses related to chronic disability/illness

Loss of caregiver

Rejection, abuse, or abandonment by caregivers

Adolescent

Multiple losses related to chronic disability/illness

Change in body image

Inability to achieve developmental task (role identity)

Loss of bodily functions

Loss of significant other (peer, family)

Older Adult

Cognitive deficits

Loss of independence

Loss of significant others, things (in general)

Motor deficits

Sensory deficits

Adolescents

Displaced individuals

Economically disadvantaged individuals

Individuals experiencing infertility

Individuals experiencing significant loss

Individuals with history of attempted suicide

Individuals with history of being abandoned

Older adults

Unemployed individuals

Critical illness

Depression

Deterioration in physiological condition

Feeding and eating disorders

Mental disorders

Neoplasms

Terminal illness

AUTHOR'S NOTE

Hopelessness, helplessness, and powerlessness are often used to describe the same situation. These concepts can overlap, but each have distinct characteristics. Merriam-Webster defines powerlessness as devoid of strength or resources and/or lacking the authority or capacity to act; helplessness as lacking protection or support, an inability to act or react, and/or not able to be controlled or restrained; hopelessness is having no expectation of good or success and not susceptible to remedy or cure. Helplessness implies that the person is weak or fragile, when in reality has learned helplessness because of past failures or unrealistic expectations of themselves, parents, or others. Powerlessness is more situational, for the individual who may usually have control over their life, but this event is viewed as unchangeable.

Hopelessness is commonly related to grief, depression, and suicide. For a person at risk for suicide, the nurse should also use the diagnosis Risk for Suicide. Hopelessness is a distinct concept and not merely a symptom of depression.

Level 3 Advanced Focused Assessment (all settings)

Choice or Control in Situations

What does the individual perceive to be his or her most difficult problem? Why?

Does this person see no possibility that his or her life will improve?

Does the person maintain that no one can do anything to help?

What does he or she believe is the solution? Is this solution realistic?

Future Options

What does the person believe the future will bring? Negative or positive things?

Can this person describe something to which he/she is looking forward to happening?

Does this person have suicidal thoughts? If so, refer to Risk for Suicide.

Has there been a change in their usual activities of daily living, sleep, appetite, eating patterns, exercise, recreation?

Meaning and Purpose in Life

What does the person value most in life? Why?

What kind of relationship does he or she have with God or a higher being?

Level 1 Fundamental Focused Interventions (all settings)

Ask them what would make them more comfortable.

Explain that there are "techniques" that can reduce anxiety. "This does not mean your anxiety/fears are not real, but they can be reduced."

Encourage relaxation breathing and aromatherapy with application of essential oils.

• Relaxation breathing: slowly breathe in through nose (3 seconds) and slowly breathe out through pursed lips (3 seconds). "Keep repeating until you feel the anxiety lessening."
• Stand in front of the person (adult, child), and demonstrate the breathing. Advise the more they practice this breathing, the more effective and natural it will become.
• Aromatherapy: use a diffusor or apply essential oil (lavender, lemon) to wrist pulse points and, if they want, lightly under the nose.

R: Aromatherapy is a complementary and alternative medicine practice that taps into the healing power of scents from essential oils extracted from plants in order to balance your mind, body, and spirit.Essential oils can be diluted by water and diffused into the air or a few drops can be gently rubbed into acupressure points on the body. Studies have shown that specific essential oils used in aromatherapy can help relieve stress, relax the body, and promote better sleep (*Chang & Shen, 2011; Wei, 2016).

CARP'S CUES

This author practices in an assistive living facility and a memory/dementia facility. I carry lavender and lemon oil in my pocket and utilize it to reduce anxiety. It works on cognitively alert residents and on those severely impaired cognitively. I recommend it to residents who can apply it themselves.

Level 3 Advanced Focused Interventions (nonacute all settings)

• Demonstrate increased energy, as evidenced by an increase in activities (e.g., self-care, exercise).
• Express desirable expectations for the near future. Describe one's own meaning and purpose in life.
• Demonstrate initiative, self-direction, and autonomy in decision-making. Demonstrate effective problem-solving strategies.
• Redefine the future, setting realistic goals with expectations to meet these goals.

Interventions

Healthcare Team

• Develop a positive, trusting relationship by:
  • Answering questions, being honest
  • Asking the individual what would make him or her more comfortable
  • Respecting feelings
  • Providing consistent care
  • Following through on requests
  • Touching, if comforting
  • Providing comfort
  • Conveying a positive attitude
• Convey attitude of "We care too much about you to let you just give up," or "I can help you."

R:The healthcare team must be hopeful if the individual is to be hopeful; otherwise, the individual views efforts of the team is a waste of time (Boyd, 2018).

Assist to Identify and Express Feelings

R:This gives the individual permission to talk and explore his or her life, which is a hopeful intervention (Robinson et al., 2012).

• Listen actively, treat as an individual, and accept his or her feelings. Convey empathy to promote verbalization of doubts, fears, and concerns.
• Validate and reflect impressions with the person. It is important to realize that those with possible terminal illness often have their own reality, which may differ from the nurse's.
• Assist the individual to understand that he or she can deal with the hopeless aspects of life by separating them from the hopeful aspects. Help to distinguish between the possible and impossible.

R:Recognizing that hopelessness is part of everyone's life and demands recognition. "Promotion of a sense of hope has been correlated with positive health outcomes, symptom reduction, and development of future orientation" (Froggart & Liersch-Sumkis, 2014, p. 98).

Assess and Mobilize Internal Resources (Autonomy, Independence, Rationality, Cognitive Thinking, Flexibility, Spirituality)

R:Watson (*1979) has identified hope as both a curative and a "carative" factor in nursing. Hope, with faith and trust, provides psychic energy to draw on to aid the curative process.

• Emphasize strengths, not weaknesses.
• Identify areas of success and usefulness; emphasize past accomplishments. Use this information to develop goals with the individual.
• Assist in identifying things he or she has fun doing and perceives as humorous. Such activities can serve as distractions to discomfort and allow the individual to progress to cognitive comfort (*Hinds, Martin, & Vogel, 1987).
• Assist in adjusting and developing realistic short- and long-term goals (progress from simple to more complex; may use a "goals poster" to indicate type and time for achieving specific goals). Attainable expectations promote hope.
• Encourage "means-end" thinking in positive terms (i.e., "If I do this, then I'll be able to...").
• Foster light-heartedness and the sharing of uplifting memories.

R:Hopelessness can be painful, but with guidance can lead to self-discovery (*Watson, 1979).

Assist with Problem-Solving and Decision-Making

• Respect the person as a competent decision-maker; treat his or her decisions and desires with respect.
• Encourage verbalization to determine their perception of choices.
• Correct misinformation.
• Assist in identifying those problems he or she cannot resolve to advance to problems he or she can. In other words, assist to move away from dwelling on the impossible and hopeless and to begin to deal with realistic and hopeful matters.
• Assess the individual's perceptions of self and others in relation to size. (People with hopelessness often perceive others as large and difficult to deal with and themselves as small.) If perceptions are unrealistic, assist to reassess them to restore proper scale.

R:Motivation is essential to recovering from hopelessness. The individual must determine a goal even if he or she has a low expectation of achieving it. The nurse is the catalyst to encourage the person to take the first step to identify a goal (Robinson et al., 2012).

R: Aromatherapy is a complementary and alternative medicine practice that taps into the healing power of scents from essential oils extracted from plants in order to balance your mind, body, and spirit.Essential oils can be diluted by water and diffused into the air or a few drops can be gently rubbed into acupressure points on the body. Studies have shown that specific essential oils used in aromatherapy can help relieve stress, relax the body, and promote better sleep (*Chang & Shen, 2011; Wei, 2016). Music therapy, aromatherapy, and massage with essential oils were found to help individuals learn to release stress and express feelings to adapt to current life and face the impact of illness with a positive attitude (*Yeh & Yeh, 2007).

Encourage to think beyond the moment.

R:People can cope with a part of life they view as hopeless if they realize that other factors in life are hopeful. For example, a person may realize that he or she may never walk again, but will be able to go home, be with grandchildren, and move around. Therefore, hopelessness can lead to the discovery of alternatives that provide meaning and purpose in life. It is essential to keep hopelessness out of the way of hope (Robinson et al., 2012).

• Explain the benefits of distraction from negative events.
• Teach and assist with relaxation breathing techniques before anticipated stressful events, (e.g., breathe slowly in through the nose and slowly exhale through pursed lips), Encourage to practice to improve effectiveness.
• Teach to maximize aesthetic experiences (e.g., smell of coffee, back rub, feeling warmth of the sun, or a breeze) that can inspire hope.
• Teach to anticipate experiences he or she delights in daily (e.g., walking, reading a favorite book, writing a letter).

Assess and Mobilize Their External Support Systems and Resources

Family or Significant Others

• Explain to family members their role in sustaining hope through supportive, positive relationships. Clarify that hope has many components, such as hope the chemotherapy works, hope the pain can be controlled to hope for a peaceful, comfortable death.
• Involve the family and significant others in plan of care. Discuss attainable goals with family. Do they agree?

R:Maintaining family role responsibilities is essential for hope and coping. In addition, realistic hope is essential for families of the critically ill to facilitate coping and adjustment.

• Use touch and closeness if appropriate with the person to demonstrate respect/caring to the family.
• Herth (*1993) found the following strategies to foster hope in caregivers of terminally ill people:
  • Cognitive reframing—positive self-talk, praying/meditating, and envisioning hopeful images (this may involve letting go of expectations for things to be different, for example, the person will recover)
  • Time refocusing—focusing less on the future and more on living one day at a time
  • Belief in a power greater than self—empowering the caregiver's hope
  • Balancing available energy—Engaging favorite activities and connecting with friends to empower the caregiver's hope through uplifting energy

R:Hope is related to help from others, in that an individual believes external resources may be supportive when his or her internal resources and strengths seem insufficient to cope (i.e., a family or significant other is often a source of hope) (*Benzein & Berg, 2005).

Support Groups

• Encourage to share concerns with others who have had a similar problem or disease and positive experiences from coping effectively with it.
• Provide information on self-help groups (e.g., "Make today count"—40 chapters in the United States and Canada; "I can cope"—series for individuals with cancer; "We Can Weekend"—for families of individuals with cancer).

R:Isolation, concurrent losses, and poorly controlled symptom management hinder hope (Öztuni˛, Yes¸il, Paydas¸, & Erdog˘an, 2013).

God or Higher Powers

• Assess the individual's belief support system (value, past experiences, religious activities, relationship with God, meaning and purpose of prayer; refer to Spiritual Distress).
• Create an environment in which the individual feels free to express spirituality.
• Allow the individual time and opportunities to reflect on the meaning of suffering, death, and dying.
• Accept, respect, and support the hope in a higher power.

R:Mihaljevic´ et al. (2012) found high indices of hope in people who have a relationship with a higher being, participate in religious services, and can control their immediate environment. Spiritual practices provide a source of hope.